Worker Interview - DSA

Worker Interview

General Information

Project Name: Yates High School - HISD

Prime Contractor: DivisionOne Construction, LLC

Subcontrctor: Miranda Trucking & Services Inc.

Interview Detail

Date

Worker Name

Auditor Name

Remarks

10/10/2019 10:41 AM

Balthazar Galaviz

Victor Bowen

None

ethnicity

gender

ssn

badge

Hispanic

Male

1234

No

Job Classification

Union Member?

Apprentice?

Period

Equipment Operator-Heavy Equip

No

No

8

Start Date

Last Work Date

Hours Last Worked

Pay Rate

10/03/2019

10/09/2019

8.00

18.00

Pay Type

Pay Day

deductions

OSHA

Paycheck

Friday

No

No

Misc Details

Tools 1

Tools 2

Tools 3

Tools 4

Backhoe

Shovel

Roller

None

Provides Tools?

Provides Materials?

Worked Overtime?

Hours Last Week

Yes

No

No

16.00

Other Work?

Other Training?

Experience

Certifications

None

None

40.00

None

Aware of Postings?

Threatened?

No

No

Signatures

Employee Signature

Auditor Signature